Arnold Stone

Turning 65 might bring you mixed emotions. Understandably, this new phase has a lot of uncertainties and mystery. Health care and insurance coverage is no exception to that uncertainties.

Many seniors are worried about the rising cost of healthcare expenses. Because of that, finding the right health coverage is crucial. As you begin searching for healthcare coverage, take a look at these options first.

Different Health Coverage For Senior Citizens

It is important to know how various health coverage can help you. That way, you can plan ahead and know how you can utilize your options in the most effective way. Here are some of them:

Medicare

A federal health insurance program that is given once you turn 65 years old. But there are also younger ages that qualify for the program and people with End Stage Renal Disease.

Medicare has different parts which cover different kinds of medical services.

Part A –is the patient insurance which covers services while you are confined to a hospital or other facilities. It also covers care in a skilled nursing facility, hospice care, and some home health care.

Part C – This type is provided by private insurance companies and is also known as Medicare Advantage plans. It has all the benefits of Medicare Part A and Part b. It also offers prescription drug coverage.

Part D – is the prescription drug insurance that is also offered by Medicare-approved private insurance companies.

Medicare Supplemental Insurance Plans

Medicare is one of the perks of turning 65. Because of it, you’ll have assistance in handling healthcare expenses. But if you are someone who needs more medical attention than what Medicare can cover, what should you do?

Medicare covers only up to 80% of healthcare costs, so if you don’t have Medigap, you will pay the remaining 20% out of your pocket. In the long run, out-of-pocket expenses such as deductible and copays may pose a risk to your finances and become a burden.

Ten Standardized Plans

Medigap has ten standardized plans, each named with alphabet letters and offers different levels of coverage. Standardized means same letter plan provide same exact benefits no matter which insurance company sells it. The difference they’ll have is the cost of the premium which varies across different carriers.

What if I don’t have a Medigap plan?

If you don’t have a Medicare supplement plan, you might possibly end up with these out-of-pocket expenses:

2019 Out Of Pocket Costs without a Medigap Plan

What You Will Pay

Medicare Part A Deductible

$1,364 per benefit period

Coinsurance (days 61-90)

$341/day

Coinsurance (days 91 and beyond)

$682/day

If you use all the lifetime reserve days

You will shoulder All costs

Skilled nursing facility coinsurance days 21-100

$170.50/day

Medicare Part B deductible

$185

If I have a Medigap Plan, how much will I be paying out-of-my pocket?

Different types of Medigap plan offer different levels of benefit. A plan may cover all or part of the out-of-pocket healthcare expenses left by Original Medicare.

Let say you chose to have a Medigap plan G, which is a type of Medicare supplement that provides comprehensive benefits. If you buy this plan, your out-of-pocket expenses may be just the Medicare part B deductible which is just $185 for 2019.

Long term care insurance

All of us are at risk of needing some form of long term care at any point in our lives, especially in retirement. Because of a lot of factors, women are most likely to need long term care.

Long term care services are also expensive just like health care costs. And the cost is estimated to continue to get higher over time. Since everyone is at risk of needing long term care, it is crucial to have a plan in place and most importantly protection against it. Long term care insurance can provide protection against the debilitating effects of long term care. It will not only provide protection for you but also to your family and assets in various ways.

LTC insurance is the coverage for nursing home care, home health care, personal or adult day care for seniors with chronic or condition that needs constant care.

Medicaid

Medicaid provides coverage to the most vulnerable senior citizens. It provides health coverage for people with low income and people with disabilities. you should meet the required income and asset standards and some specified eligibility.

Medicaid provides broad health insurance coverage including doctor visits, hospital expenses, home health care, long term care costs both in a nursing home and at home care. Long term care is not covered by Medicare nor Medicare Supplement plans.

Finding the plan

It is important to know ahead of time which plan you would like to take advantage. That way, you will be able to maximize the coverage, manage your health care expenses effectively and avoid certain penalties in the long run.

Medicare Part A assists paying for inpatient care in a hospital or skilled nursing facility. But there’s more to it than that.

There is some cost sharing with Medicare Part A, which includes deductibles. Medicare Part A deductibles are different from a typical deductible in health insurance for people under 65. You pay a deductible for each “benefit period,” rather than for the calendar year. A benefit period starts the day you go into a hospital or skilled nursing facility. It ends when you have been out of the facility for 60 consecutive days.

You may be admitted multiple times to the hospital during one benefit period. For example, you schedule a minor procedure in the hospital and are there only a short stay and then released. Then you go back into the hospital the next week for a different health problem. That means you have 2 hospital stays within 1 benefit period, which means you would only pay 1 deductible for both stays in the hospital.

Once your last stay at the hospital has passed 60 consecutive days, you next hospitalization will be the beginning of a new benefit period. This is true even if you go into the hospital a 2nd time for the same health problem. You would pay 2 deductibles, 1 for each benefit period.

Medicare Part A helps in paying for up to 90 days of hospital or skilled nursing care for each benefit period. Part A covers a limitless number of benefit periods.

Lifetime Reserve Days and Medicare Part A

Lifetime reserve days are extra hospital days covered by Medicare. They are able to be used if you are in the hospital or a skilled nursing facility for more then 90 days. You have 60 extra covered days in your account that you can use throughout the rest of your life.

Important things to Remember About Part A and Benefit Periods:

You pay a Part A deductible for each benefit period.

A benefit period begins when you enter the hospital and ends when you are out for 60 consecutive days.

Medicare Advantage Plans (Part C plans) are offered by private Medicare-approved companies. These plans provide you with Original Medicare coverage, Part A and Part B, plus extra services -most also include Medicare Part D prescription drug coverage. The amount you pay and your additional services vary by plan. Here’s a basic overview of the 6 types of plans.

Health Maintenance Organization (HMO) Plans These Medicare Advantage Plans are available in some areas of the country. Most HMO’s require you to use a select network of doctors and health care providers. You are also required to use an in-network primary care physician to coordinate your overall care and refer you to any specialists as needed.

Point of Service (POS) Plans This is a second managed care option that allows you to see out-of-network doctors at a higher cost than in-network doctors. Also, you can usually see in-network specialists without a referral from your primary care physician.

Preferred Provider Organization (PPO) Plans This is a third type of managed care plan –available in local or regional areas. They don’t always require you to choose a primary care provider. However, seeing an out-of-network doctor usually costs more. Certain plans require you to pay a physician directly and then file a claim with your PPO.

Private Fee-For-Service (PFFS) Plans PFFS plans are not managed care plans, therefore they work without health care provider networks. You can see any Medicare-eligible doctor or hospital that agrees to accept payment from your plan. Some plans require you to pay the doctor directly and then submit a claim to your insurance company, which then pays you back.

Medical Savings Account (MSA) Plans These plans combine a High Deductible Health Plan (HDHP) and a special bank account fund (the MSA). You can use the money in this account to pay for your health care costs, however, only Medicare-covered expenses count toward your deductible. Once you’ve paid the deductible, the plan covers expenses normally covered under Medicare. MSA plans do not include Medicare Part D prescription drug coverage, so policy owners need to purchase a stand-alone Part D plan.

Special Needs (SNPs) Plans These plans serve people with specific diseases or medical needs. This can include people with certain chronic diseases and conditions, some are for people who have both Medicare and Medicaid and some are for people who live in an institution (IE nursing home). The plans customize benefits, health care provider choices, and covered drugs to best meet the specific needs of the groups they serve.

There are four basic parts of Medicare: Medicare Part A, Medicare Part B, Part C, and Part D. I’m going to break down Medicare Part A including how to qualify for it, when you get it, and what exactly it covers.

Qualifying for Medicare Part A

You qualify for Medicare Part A if you have worked at least 40 quarters (ten years) while paying Medicare taxes, or if you are the spouse of someone who has worked the ten years. You may also qualify for Medicare Part A if you have a diagnosed disability for at least 24 months. You will not have to pay for Medicare Part A if you meet these requirements. Remember those Medicare taxes that were coming out of your check every month? Well Medicare Part A is what you were paying for all those years. If for some reason you only had worked over 30 quarters, but did not make it to 40 quarters you are still able to buy Medicare Part A for a reduced premium. The current premium in 2017 is $227. If you didn’t make it to even 30 quarters, or if you don’t qualify any other way, you will have to pay the full premium of $413 in 2017.

When Can I Enroll Into Medicare Part A

You will likely be able to enroll into Medicare Part A when you turn 65 years of age, or if you have been diagnosed with a disability, and have received benefits for at least 24 months. I write in more detail about this subject in my post about qualifying for Medicare.

Medicare Part A Coverage

Medicare Part A is not complete Medicare coverage. You will want Medicare Part B and Medicare Part D as well. In some cases you may even elect to enroll into Medicare Part C. Medicare Part A is known as hospital coverage. Don’t think that this means that it covers an entire hospital stay because is does not. Medicare Part A covers the following:

Inpatient Hospital Care – this is for things like a semi-private room, supplies, and drugs as part of your treatment

Skilled Nursing Care – in a skilled nursing facility under certain conditions for a limited time

Hospice

Home Health Services – intermittent skilled nursing care along with some therapy and continued occupational services

Expect to pay the following:

Inpatient Hospital Deductible – $1316 for 2017 – Can be applied multiple times for different occurrences and covers days 1-60

Hospital Co-pay – Days 61-90 is $329/day in 2017

Skilled Nursing Facility – Days 1-20 is $0; Days 21-100 is $164.50/day in 2017

Hospice – $0

Home Health Services – $0

Notice what is lacking from your hospital coverage is doctor services. If you require surgery, that cost falls under Medicare Part B, along with any other doctor provided services. This is why Part A is not enough and must have Part B included with it. Also, notice that you still have out of pocket costs with Medicare Part A. You will still have some substantial costs to pay when you go to utilize your Medicare Part A coverage. This is why you may want to consider some other kind of supplemental coverage along with your Medicare coverage.